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Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis

송재훈|이상무|박동아|백경란|정두련|강철인|주은정
대한내과학회 (The Korean Association Of Internal Medicine)|2019.11|The Korean Journal of Internal Medicine|제34권 제6호|pp. 1347-1362|DOI https://doi.org/10.3904/kjim.2017.098

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키워드

MortalityStaphylococcus aureusBacteremiaEndocarditisMethicillin resistance
주제분류내과학

초록

Background/Aims: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation. Methods: We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011. Results: A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17). Conclusions: MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.

Abstract

Background/Aims: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation. Methods: We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011. Results: A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17). Conclusions: MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.

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관련 논문AI추천

Clinical and microbiological factors associated with early patient mortality from methicillinresistant Staphylococcus aureus bacteremia김탁, 김성한, 김양수, 박기호, 박수진, 방경미, 우준희, 이상오, 정용필, 정진용, 최상호대한내과학회 · The Korean Journal of Internal Medicine2019 · 제34권 제1호Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study김기훈, 김병기, 김준명, 박만제, 위유미, 이현수, Hea Sung Ok대한내과학회 · The Korean Journal of Internal Medicine2013 · 제28권 제6호Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia추은주, Henry F. Chambers대한감염학회 · Infection and Chemotherapy2016 · 제48권 제4호Microbiological and genotypic factors affecting mortality in methicillin-resistant Staphylococcus aureus bacteremia주은정대한내과학회 · The Korean Journal of Internal Medicine2019 · 제34권 제1호Impact of Methicillin-Resistance on Mortality in Children and Neonates with Staphylococcus aureus Bacteremia: A Meta-analysis박동아, 백경란, 오의금, 이상무, 주은정대한감염학회 · Infection and Chemotherapy2013 · 제45권 제2호A Comparison of Clinical Features and Mortality among Methicillin-Resistant and Methicillin-Sensitive Strains of Staphylococcus aureus Endocarditis김장오, 김준명, 송영구, 윤희정, 최준용연세대학교의과대학 · Yonsei Medical Journal2005 · 제46권 제4호

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